Organization
ALTAMAHA PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY KIRK AGACNP, RN (OWNER/PRESIDENT)
(912) 559-2420
Entity
Organization
Contact information
Practice address
248 NE BROAD ST, JESUP, GA 31546-4371
(912) 559-2696
(912) 559-2420
Mailing address
248 NE BROAD ST, JESUP, GA 31546-4371
(912) 559-2696
(912) 559-2420
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G07348B
—
GA
Enumeration date
11/29/2021
Last updated
11/29/2021
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